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患者,女,43岁。入院前2月余体检发现心脏扩大,当时无任何症状。入院前1月余自感心累、心悸、乏力,经肌苷、ATP、辅酶A、细胞色素C、青霉素等治疗10天。入院前1周,上述症状加重,以“上感,病毒性心肌炎”诊断,于1992年1月6日入院。查体T37.2℃,P92次/分,R18次/分,BP18/11kPa。无皮疹,浅表淋巴结未扪及,咽部轻度充血,双肺清晰,心率92次/分,第一心音略低钝,心尖区SMⅡ,肝肋下刚及,质软,脾末及。双下肢无浮肿。关节无红肿及活动障碍。实验室检查:外周血象Hb 98g/L,WBC 7.5×10~9/L,N0.66.L 0.34,ESR13mm/小时,抗“O”阴性。心肌酶谱AST291U/L,CK 1013IU/L,LDH 1531U/L,HBD1281U/L。胸片:心影向左右两侧扩大,心胸比率约0.6,心膈面延长,心脏向左扩大较向右扩大为显,心影两缘各弧弓尚能辨认。心电图,窦性心律不齐,电轴左偏(18°),偶见室性早搏、低电压。超声心动图和B超均提示少量心包积液。入院后考虑病毒性心肌炎
Patient, female, 43 years old. Two months prior to admission, physical examination revealed enlargement of the heart at that time without any symptoms. More than one month before admission, I felt tired, palpitations and fatigue, and treated with inosine, ATP, coenzyme A, cytochrome C and penicillin for 10 days. One week before admission, the above symptoms aggravate. The diagnosis was made on the “sense of the flu and viral myocarditis” and was admitted on January 6, 1992. Physical examination T37.2 ℃, P92 beats / min, R18 beats / min, BP18 / 11kPa. No rash, no palpable superficial lymph nodes, mild pharyngeal hyperemia, clear lungs, heart rate 92 beats / min, the first heart sound slightly blunt, apex SM Ⅱ, liver and ribs just, soft, . No lower extremity edema. Joints without swelling and movement disorders. Laboratory tests: peripheral blood Hb 98g / L, WBC 7.5 × 10 ~ 9 / L, N0.66.L 0.34, ESR13mm / hour, anti “O” negative. Myocardial enzymes AST291U / L, CK 1013IU / L, LDH 1531U / L, HBD1281U / L. Chest X-ray: heart shadow to the left and right sides to expand the ratio of about 65 heart and chest, heart diaphragmatic extension of the heart to the left to expand to the right to expand significantly, heart arc two arcs can still identify. ECG, sinus arrhythmia, axial left deviation (18 °), occasionally ventricular premature beats, low voltage. Echocardiography and B-mode suggest a small amount of pericardial effusion. After admission to consider viral myocarditis